PROJECT SUMMARY/ABSTRACT This Phase 1 SBIR proposal focuses on increasing ventilation safety for patients as they recover from surgery in the hospital while also reducing the work burden for clinicians.The underlying cause in 2 of every 3 unexpected hospital deaths is hypoventilation, a condition in which patients do not breathe enough. After surgery, many patients receive medication to control pain which can severely reduce their drive to breathe. The patient deaths that follow are clearly preventable if hypoventilation is detected early and the patient is awakened and prompted to breathe. In this project, we will build on a promising preliminary study to further develop an automated system that interacts directly with the patient to prompt them to breathe and is intuitive for clinicians to use. We plan to place a small wireless motion sensor and a low- cost pulse oximeter on the finger and a respiration monitor on the nose. When these sensors detect hypoventilation and very little hand motion with low oxygen saturation, the automated system will use a speaker by the bedside to wake the patient and directly verbally prompt them by name to breathe. If the patient does not respond, the system will immediately notify the nurse that help is needed. A display of breath prompting, breath rate and oxygen saturation history will help clinicians decide whether medication doses should be adjusted to prevent further hypoventilation. This proposal will allow advancement of the hardware, algorithm and user interface used in preliminary work as well as conduct a human clinical study to assess effectiveness and reduction in nurse workload. In Phase II, the device will be refined and tested in patients on the general floor. Axon's team has demonstrated commercial success with several devices and looks forward to bringing this device through FDA 510(k) to commercialization and preventing unexpected hospital deaths from hypoventilation.